Achilles tendinitis/tendinosis and plantar fasciitis/fasciosis are two common causes of heel and ankle pain. Both are injuries that result from overuse and which may flare up following prolonged activity. However, they can also show up after a more minor event – the proverbial ‘straw that broke the camel’s back.’
There are a number of predisposing factors that may have been occurring for a long time, or they might be new to you, such as:
- Abnormal foot biomechanics including overpronation (fallen arches)
- High activity level
- Walking/standing on hard surfaces
- Being overweight
- Poor footwear
Tendinitis means inflammation of a tendon. In recent years biopsy studies have looked at pieces of tendon under a microscope and found that there is no inflammation in most cases, but instead that the tendon is breaking down, like a rope that is fraying. This gave rise to the new term for painful tendons: tendinosis.
Achilles tendinosis is where the Achilles tendon is fraying where it attaches at the back of the heel. It is often caused by excessive inward rolling of the heel due to abnormal foot mechanics, and often becomes painful with increased activity, such as increasing the number of miles you walk or run.
If you look at a muscle chart, muscles are red because they have such a rich blood supply, and tendons and ligaments are white because the blood supply is so poor. If you overdo it at the gym and strain a muscle, usually the pain goes away within a few days because the rich blood supply helps it heal up so well. However, if you overwork a tendon or ligament and tear a few of its fibers, it often does not heal well because it has such a poor blood supply.
Achilles tendinosis is notoriously resistant to treatment. Treatments typically include TENS, ice, rest, stretching and strengthening exercises, and electrostim therapy. Newer treatments include laser therapy, Active Release Technique (ART), Graston therapy, etc. These treatments work better, but the results are not guaranteed as the tendon maintains its small tears and continues to have a poor blood supply.
The best treatment for Achilles tendinosis is shockwave therapy. It has an 85% – 90% success rate. Shockwave therapy is the same treatment used to get rid of kidney stones. The process involved in shockwave therapy is emitting a powerful sound wave (not ultrasound) that travels deep into the damaged tendon to create micro trauma that stimulates the body to repair itself by angiogenesis – growing new little arteries in the tendon – thereby increasing the blood supply and allowing the tendon to heal.
The shockwave does not damage the skin and other tissues that the sound travels through. MRI studies show the tendon is thicker after treatment than it was before treatment, confirming that the tendon actually regenerates.
Once the pain is gone, it is sometimes recommended that custom foot orthotics be worn to correct abnormal foot mechanics that may have predisposed you to this condition. This will help prevent the Achilles tendinosis from returning months or even years later (if poor foot mechanics were indeed a predisposing factor).
Contact Alberta Back and Neck Rehab & Sports Injuries Clinic to find relief for your Achilles pain. Calgary patients from all over can seek the help of our chiropractors.